Drug-resistant Tuberculosis Patients Research Articles

Baseline glycated hemoglobin and potassium level correlated with pretreatment QT-corrected interval among patients with diabetic drug-resistant tuberculosis.

Bedaquiline is a core drug with an optimized background regimen for treating drug-resistant tuberculosis (DR-TB) patients. One of the adverse effects of bedaquiline is QT-corrected (QTc) interval prolongation. TB patients with diabetes mellitus (DM) are more likely to develop QTc interval prolongation during TB treatment than those without DM. This study aimed to correlate baseline electrolyte levels (potassium, calcium, and magnesium), thyroid-stimulating hormone (TSH), body mass index (BMI), blood glucose, glycated hemoglobin (HbA1c), and pretreatment QTc interval among patients with diabetic DR TB who received regimens containing bedaquiline. It was a prospective study with a cross-sectional design. Blood samples, BMI, and electrocardiogram were collected at baseline before starting the regimen for DR-TB. Pearson correlation was used to correlate between baseline electrolyte level, TSH, BMI, complete blood count, blood glucose, HbA1c, and pretreatment QTc interval. Seventy-two DR-TB patients met the inclusion criteria, half with DM. The blood glucose and HbA1c were significantly higher in patients with DM. Pretreatment QTc interval was similar between the two groups. Levels of calcium, magnesium, TSH, blood glucose, and BMI were not correlated with pretreatment QTc interval. There was a correlation between baseline potassium and HbA1c levels with pretreatment QTc interval (P < 0.05; r = 0.357 and r = -0.376, respectively). Baseline potassium level correlates with the pretreatment QTc interval in those without DM. Baseline HbA1c and potassium levels correlate with pretreatment QTc interval among DR-TB patients with DM. Our study indicates the importance of monitoring HbA1c and potassium levels during DR-TB therapy containing bedaquiline for early detection of QTc prolongation.

A deep learning-based framework for automatic detection of drug resistance in tuberculosis patients

Tuberculosis (TB), caused by mycobacterium tuberculosis, is one of the most severe respiratory diseases that kill thousands of people annually around the world. Late diagnosis and drug resistance adversely affect the treatment plan. This paper introduces several deep learning models for TB diagnosis from CT scans. Specifically, for the detection of multi-drug resistance and for the detection of the TB types. These models are multi-channel models as they take, as input, the image frame, the mask frame and the gender/age data to make the final classification. Transfer learning based on VGG19 and ResNet neural networks were used for feature extraction from CT scans. The best performing model, for the classification of multi-drug resistance, was a three-channel model which used VGG19 for feature extraction and a cascade of convolutional and dense layers for classification with accuracy equals to 74.13% and AUC equals to 64.2%. By comparison, the best performing model for the TB type classification, employed the ResNet for feature extraction and a cascade of convolutional and dense layers for classification with accuracy equals to 53% and Kappa index equals to 34.3%. These results outperform the reported results in the literature for the same type of tasks. The dataset was obtained from the Image CLEFF 2018 data on TB.

Prevalence and Determinants of Depression Among Multi Drug Resistant (MDR) TB Cases

Aim: We aimed this study to find the prevalence of depression among multi drug resistant (MDR) TB patients and its related determinants. Material and methods: An observational cross-sectional study was conducted at Jinnah Postgraduate Medical Center Karachi hospital, we enrolled 107 MDR-TB patients using non-probability consecutive sampling. Patients were evaluated for depression using Patient Health Questionnaire-9 (PHQ-9). Prevalence of depression along with its determinant were assessed. We used Chi Square test for association between depression and its determinants keeping P value &lt; 0.05 was taken as statistically significant. Results: Patients’ mean age was 32.10±6.19, male patients were higher in number as compared to female patients. In our study we found that depression was present in 52 (48.6%) patients. Depression had significant association with financial issues, family problems, treatment duration and increasing age. Practical implication: Current study assess the determinants of depression in TB patients and spreads public awareness in community about Multidrug resistance in TB and ways to avoid TB in local population. Conclusion: From our study we conclude that 52 (48.6%) patients had depression in MDR-TB patients which is an alarming situation. Financial issues, family problems, treatment duration and increasing age were found to the determinants of depression in MDR-TB patients. Keywords: Tuberculosis, Multi Drug Resistance, Depression, Truenat, Xpert, Mental disorders, psychiatric comorbidity

Second-line drug resistance markers as proxy indicators of time to sputum culture conversion among second-line drug resistant tuberculosis patients tested in Uganda: A cross-sectional study

Background Increased tuberculosis disease burden arises as a result of low treatment success rates stemming from the emergence of second-line drug resistance. We aimed at determining the usefulness of second-line drug (SLD) resistance markers as proxy indicators of time to sputum culture conversion; a renowned predictor of Tuberculosis treatment outcome, among SLD-resistant tuberculosis (TB) patients tested at the Uganda National TB Reference Laboratory (NTRL). Methods A cross-sectional study was conducted on 72 bacteriologically confirmed SLD resistant TB patients with datasets including culture conversion time and second line probe assay mutation profiles between 01/06/2017 and 31/12/2019. The data were then imported into STATA v15 for descriptive statistical analysis, Univariate cox proportional hazard model analysis and Kaplan-Meier survival curves at a 5% level of significance; p-value ≤0.05. Results Results indicate the median time was achieved at 3 (0–12) months across the studied patients. The rrs G1484T mutation associated with conferring drug resistance to injectable agents was observed to have the shortest median conversion time of 1.5 months, longest by the gryB E540D at 5 months. A single mutation in the gryA gene locus showed higher converted proportions 70.8% (58.9–81.0) than those that had two 8.3% (3.1–17.3) or three 2.7% (0.3–10.0) mutations. Conclusions The studied second-line drug resistance markers had no statistically significant association with the time to sputum culture conversion, although increased drug resistance levels reduced the converted proportions and stressed the need to utilize molecular diagnostics data and other crucial variables to better comprehend proxy indicators of SLD resistant tuberculosis management.

Missing Cases of Bacteriologically Confirmed TB/DR-TB from the National Treatment Registers in West and North Sumatra Provinces, Indonesia

This study aimed to assess the percentage of confirmed drug-sensitive (DS) TB and drug-resistant (DR) TB patients who were missing in the national treatment registration in North Sumatra and West Sumatra, where treatment services for DR-TB in North Sumatra are relatively well established compared with West Sumatra, where the system recently started. Confirmed DS/DR-TB records in the laboratory register at 40 government health facilities in 2017 and 2018 were traced to determine whether they were in the treatment register databases. A Jaro-Winkler soundexed string distance analysis enhanced by socio-demographic information matching had sensitivity and specificity over 98% in identifying the same person in the same or different databases. The laboratory data contained 5885 newly diagnosed records of bacteriologically confirmed TB cases. Of the 5885 cases, 1424 of 5353 (26.6%) DS-TB cases and 133 of 532 (25.0%) DR-TB cases were missing in the treatment notification database. The odds of missing treatment for DS-TB was similar for both provinces (AOR = 1.0 (0.9, 1.2), but for DR-TB, North Sumatra had a significantly lower missing odds ratio (AOR = 0.4 (0.2, 0.7). The system must be improved to reduce this missing rate, especially for DR-TB in West Sumatra.

Adverse reaction monitoring in drug resistance tuberculosis patients in a Northern Karnataka district

Adverse reaction monitoring in drug resistance tuberculosis patients in a Northern Karnataka district

Оценка безопасности применения тиоуреидоиминометилпиридиния перхлората (Перхлозон) в схеме терапии лекарственно-устойчивого туберкулеза у пациентов с ВИЧ-инфекцией

Оценка безопасности применения тиоуреидоиминометилпиридиния перхлората (Перхлозон) в схеме терапии лекарственно-устойчивого туберкулеза у пациентов с ВИЧ-инфекцией

Ophthalmic evaluation of drug-resistant tuberculosis patients taking linezolid as oral longer anti-tuberculosis regime

Aim: To document ocular toxicity if any in drug-resistant tuberculosis patients taking linezolid as an oral longer regime. Study and Design: Hospital-based Observational study. Methods and Material: The study was carried out in tertiary health care from January 2021- October 2022. A total of 94 participants above 18 years of age who were diagnosed with drug-resistant tuberculosis taking Linezolid and had pre-treatment best-corrected visual acuity (BCVA) of 6/6 and N6 with normal color vision were included in the study. Patients were called on follow-up on the 2nd, 4th, and 6th months of post-Linezolid therapy, and BCVA, color vision, anterior segment examination, and dilated fundus examination were done and documented. Results: Out of 94 participants 45 were males and 49 females. The mean age of participants was 27.41±9.22. We observed one patient developed a diminution of vision with fundus changes of optic disc edema in the second month of follow-up and the other patient also came with a diminution of vision with optic neuropathy on the sixth month of follow-up. The third patient developed nonsignificant RPE changes without diminution of vision. Conclusion: Ocular toxicity in three cases in form of Optic Neuropathy, optic disc edema, and nonsignificant RPE changes amongst 94 participants. In our study after the withdrawal of Linezolid therapy, the visual acuity and fundus changes reverted to normal. The study highlights the importance of regular ophthalmic follow-up in patients who were on long-term linezolid therapy.

СОВРЕМЕННЫЕ ПОДХОДЫ К ЛЕЧЕНИЮ БОЛЬНЫХ ТУБЕРКУЛЕЗОМ С МНОЖЕСТВЕННОЙ ЛЕКАРСТВЕННОЙ УСТОЙЧИВОСТЬЮ С ПРИМЕНЕНИЕМ НОВЫХ ПРОТИВОТУБЕРКУЛЕЗНЫХ ПРЕПАРАТОВ

According to the World Health Organization (WHO), in 2021 the number of TB patients increased worldwide and reached 10.6 million people, while in 2020 this rate was 9.9. million people. We also observed proliferation of drug-resistant TB. According to the WHO, 450,000 TB patients with multiple drug resistance (MDR) were registered worldwide in 2021, which exceeded the similar rate in 2020 by 3%. In the recent years we observed decrease in TB incidence in the Russian Federation.TB incidence was 53.3 people per 100,000 population in 2016, and 32.4 people per 100,000 population in 2020. MDR-TB prevalence was 16.4 per 100,000 population in the Russian Federation in 2021. The share of extensively drug resistant (XDR) TB patients was 22.3% in the end of 2021. Many scientists have emphasized the need for active development of novel drugs for drug-resistant (DR) TB treatment. Delamanid is one of the novel TB drugs, included in the list of DR-TB drugs by the WHO in 2015. Wide use of delamanid in MDR-TB treatment regimens may improve effectiveness of chemotherapy, also by increasing patients’ adherence to treatment, and decrease adverse events. However, use of delamanid and other novel TB drugs in MDR/XDR-TB treatment regimens requires further research.

Heteroresistance to rifampicin & isoniazid in clinical samples of patients with presumptive drug-resistant tuberculosis in Central India.

A combination of resistant and susceptible Mycobacterium tuberculosis (MTB) isolated from clinical specimens is referred to as heteroresistance. Heteroresistance leads to difficulties in drug resistance testing and may adversely affect treatment outcomes. The present study estimated the proportion of heteroresistance among MTB in clinical samples of presumptive drug-resistant tuberculosis (TB) patients in Central India. A retrospective analysis of data generated from line probe assay (LPA) at a tertiary care hospital in Central India between January 2013 and December 2018 was carried out. A heteroresistant MTB in a sample was indicated by the presence of both wild-type and mutant-type patterns on an LPA strip. Data analysis was carried out on interpretable 11,788 LPA results. Heteroresistance in MTB was detected in 637 (5.4%) samples. Of these, heteroresistance in MTB was detected in 413 (64.8%), 163 (25.5%) and 61 (9.5%) samples with respect to rpoB, katG and inhA genes, respectively. Heteroresistance is considered a preliminary step in the development of drug resistance. Delayed or suboptimal anti-tubercular therapy in patients with heteroresistance of MTB may elicit full clinical resistance and negatively impact the National TB Elimination Programme. Further studies are, however, needed to determine the impact of heteroresistance on treatment outcomes in individual patients.

Drug resistance patterns and treatment outcomes in DR-TB patients at a tertiary care centre in Mumbai

BackgroundDrug-resistant tuberculosis (DR-TB) is a major health problem and threatens Tuberculosis (TB) control and outcomes globally. India holds one-fourth of global DR-TB burden.1 Aims1- To study drug resistance patterns and outcomes in DR-TB patients under National Tuberculosis Elimination Programme (NTEP) at a tertiary care-centre. 2- To correlate outcome of DR-TB with drug resistance patterns. MethodsIt is a retrospective study of 302 Drug Resistant Tuberculosis patients from Jan 2020 to May 2022. Common mutations of drug resistance, pyrazinamide resistance in DR-TB patients, correlation of High dose Moxifloxacin sensitivity by Line Probe Assay (LPA) and drug sensitivity test (DST), outcome of DR-TB patients with drug resistance patterns and correlation of outcome of DR-TB patients with their initial body-weight were studied. ResultsKat G was the most common mutation in Isoniazid (96%) resistance for MDR TB as well as Isoniazid Mono-resistance TB (p = 0.001). 91% cases with MDR-TB were resistant to pyrazinamide. 51.2% cases had low dose Fluroquinolone resistance. 18.8% cases had low and high dose Fluroquinolone resistance. 8.5% cases had resistance to injectables. 21.7% of cases who were resistant to High dose Moxifloxacin on second line LPA were found to be sensitive on DST. Outcomes were not dependent on the LPA resistance patterns. Body-weight greater than 45 Kg at the time of initiation of treatment was associated with better outcomes (p = 0.007). ConclusionDR-TB patients are resistant to pyrazinamide in nearly all cases; hence pyrazinamide is not suitable for initial replacement sequence. Second line resistance doesn't impact outcome in DR-TB patients.

Outcomes of patients undergoing lung resection for drug-resistant TB and the prognostic significance of pre-operative positron emission tomography/computed tomography (PET/CT) in predicting treatment failure.

Surgery remains an adjunctive treatment for drug-resistant tuberculosis (DR-TB) treatment failure despite the use of bedaquiline. However, there are few data about the role of surgery when combined with newer drugs. There are no outcome data from TB endemic countries, and the prognostic significance of pre-operative PET-CT remains unknown. We performed a prospective observational study of 57 DR-TB patients referred for surgery at Groote Schuur Hospital between 2010 and 2016. PET-CT was performed if there was nodal disease or disease outside the area of planned resection but did not influence treatment decisions. 24-month treatment success post-surgery (cure or treatment completion), including all-cause mortality, was determined. 35/57 (61.4%) patients (median age 40 years; 26% HIV-infected) underwent surgery and 22/57 (38.6%) did not (11 patients were deemed unsuitable due to bilateral cavitary disease and 11 patients declined surgery). Treatment failure was significantly lower in those who underwent surgery compared to those eligible but declined surgery [15/35 (43%) versus 11/11 (100%); relative risk 0.57 (0.42-0.76); p<0.01). In patients treated with surgery, a post-operative regimen containing bedaquiline was associated with a lower odds of treatment failure [OR (95%CI) 0.06 (0.00-0.48); p=0.007]. Pre-operative PET-CT (n=25) did not predict treatment outcome. Resectional surgery for DR-TB combined with chemotherapy was associated with significantly better outcomes than chemotherapy alone. A post-operative bedaquiline-containing regimen was associated with improved outcome; however, this finding may have been confounded by higher use of bedaquiline and less loss to follow-up in the surgical group. However, PET-CT had no prognostic value. These data inform clinical practice in TB-endemic settings. This work was supported by the South African MRC (RFA-EMU-02-2017) and the EDCTP (TMA-2015SF-1043 & TMA- 1051-TESAII).

Prevalence of pre-extensively drug-resistant tuberculosis (Pre XDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) among extra pulmonary (EP) multidrug resistant tuberculosis (MDR-TB) at a tertiary care center in Mumbai in pre Bedaquiline (BDQ) era.

Drug-resistant tuberculosis (DR-TB) is the most exigent and calamitous challenge encountered in treatment of TB. Extra pulmonary (EP) DR-TB poses a complex diagnostic and therapeutic challenge owing to myriad of presentations and paucibacillary nature. Data available on this subset is limited. We studied the prevalence of EPDR-TB cases among the total DR-TB cases visiting our Programmatic management of Drug-Resistant TB (PMDT) site. We also studied the demographic and microbiological profile of these cases and analyzed the prevalence of pre-extensively drug-resistant TB (pre XDR-TB) and extensively drug-resistant TB (XDR-TB) among patients of EPDR-TB in pre Bdq era. Of the 1086 DR-TB patients, 64 (5.89%) were cases of EPDR-TB. Seven out of 64 (10.93%) were primary EPDR-TB. The site wise distribution of cases was 34 (53.125%) lymph node DR-TB, 18 (28.125%) pleural DR-TB, 9 (14.0625%) spinal DR-TB/paraspinal abscess/psoas abscess, 1 case (1.5625%) each of abdominal DR-TB, sternal and gluteal abscess. On the basis of the second-line drug susceptibility testing (DST), patients were grouped into: (1) multidrug-resistant TB (MDR-TB), (2) MDR-TB with fluoroquinolone (FQ) resistance {pre XDR XDR-TB (FQ)}, (3) MDR-TB with second-line injectable (SLI) resistance {pre XDR XDR-TB (SLI)}, (4) XDR-TB. Of the 64 patients, 43 (67.185%) had MDR-TB, 19 (29.687%) had preXDR-TB (FQ), none had preXDR-TB (SLI) and 2 (3.125%) had XDR-TB. Gastro esophageal reflux disease (GERD) was the most common comorbidity seen in 26 (40.6%) patients, followed by anemia in 5 (7.8%), psychiatry problems 5 (7.8%), hypertension in 3 (4.6%), renal disorders in 2 (3.1%) while thyroid disorder, HIV and thalassemia in 1 each (1.5%). EPDR-TB forms a small but significant proportion of total DR-TB. Lymph node DR-TB is its most common subclass. Our study emphasises the momentousness and essentiality of baseline DST to FQ and SLI in patients of DR-TB. This enables an appropriate modification of therapy at baseline itself to better the treatment outcomes. We observed a strikingly high proportion of preXDR-TB (FQ) in our study group.

Distribution of Rifampicin-Resistant Tuberculosis Patients based on Presumptive Drug-Resistant Tuberculosis Criteria at Dr. Hasan Sadikin Hospital 2016–2019

Background: Diagnosis of drug-resistant tuberculosis (DR-TB) begins with identifying presumptive DR-TB patients using Xpert MTB/RIF, as a diagnostic test to detect resistance to rifampicin. The study aimed to identify the distribution of rifampicin-resistant tuberculosis (RR-TB) patients based on presumptive DR-TB criteria at Dr. Hasan Sadikin General Hospital Bandung. Moreover, this study also explored the Xpert MTB/RIF Ct values.Methods: This was a descriptive-retrospective study from 570 medical records of DR-TB patients collected at the Multidrug-resistant tuberculosis (MDR-TB) clinic of Dr. Hasan Sadikin General Hospital from 2016 to 2019. The inclusion criteria were suspected patients with the Xpert MTB/RIF Ct values in the very low-low and medium-high categories. Data were analyzed using frequency distribution. Results: The most common presumptive DR-TB criteria among DR-TB patients were relapse cases (52.3%). Presumptive DR-TB criteria, with a high percentage result of medium-high Ct values, were category II treatment failure (80.9%).Conclusion: Relapse case and category II treatment failure are presumptive DR-TB criteria, which need more attention from clinicians.

Predictors for Mortality in Multidrug Resistant Pulmonary Tuberculosis Patients in a South Indian Region

Background: Although various factors depicting the mortality in multi drug resistant tuberculosis available there exist no concise data on the factors contributing to mortality globally. The predictors for mortality in multi drug resistant tuberculosis patients vary from localities. Objectives: The study aimed to find the factors contributing to mortality in multi drug resistant tuberculosis in Warangal district of Telangana. Materials and Methods: The prospective study determining the predictors of mortality in multidrug resistant pulmonary tuberculosis patients had a sample size of 296. The follow-up of the patients was conducted for twenty four months to determine the treatment outcome. Patients’ mortality was noted from the hospital case sheets, relatives and healthcare facilitators’ viz., National tuberculosis elimination program supervisors, Auxiliary Nursing Midwifery in case of death at home. Patients’ demography was denoted in number and percentage. Predictors for mortality determined using binary logistic regression analysis. The predictor variables significant with p&lt;0.2 in univariate analysis were considered for binary logistic regression analysis. The dependent variable was the occurrence of event - mortality and the independent variables chosen from the available literature. Results: The predictors for mortality identified as low body weight of 16-30kg (p=0.002; aOR=10.43); comorbids (p=0.002; aOR=3.21); severe radiological manifestations at admission to hospital (p=0.001; aOR=6.98) and incompliance to treatment (p=0.0001; aOR=5.06) in the present study. Conclusion: The factors identified for mortality in multidrug resistant tuberculosis patients are malleable and modifiable with timely follow-up of the patients. The results imply strengthening the anti-TB program with a multidisciplinary approach for a systematic follow-up of the patients and favorable treatment responses.

Survival Analysis of Sputum Conversion Time among Patients with Drug Resistant Tuberculosis in Kenya

Drug-resistant tuberculosis (DR-TB) is a form of antimicrobial resistance <em>Mycobacterium tuberculosis</em> that is difficult and costly to treat. It is caused by TB bacteria resistance to at least one of the first-line existing TB medications, resulting in fewer treatment options and increasing mortality rates. In 2019, close to 500,000 people developed DR-TB, and 182,000 died globally. Less than 60% of DR-TB patients who started on medication were completed, mostly due to high mortality and lost follow-up.

Anti-Tuberculosis Therapy in The Drug Resistant Tuberculosis Patients of Kashmir Valley

Drug-resistant tuberculosis (DR-TB) strains are a significant threat to global TB control. Due to a lack of resources and inadequate healthcare infrastructure, it is difficult to identify and monitor drug resistance situations in low and middle-income nations. The study aimed to evaluate the anti-tuberculosis therapy regimen in drug-resistant tuberculosis patients of the mountainous valley of Kashmir. The current study was carried out at Government Medical College, Department of Pulmonary Medicine, Chest Diseases Hospital (CDH), Srinagar, Kashmir. A total of 1100 suspected tuberculosis subjects were included in the study, and out of 1100 TB subjects, 195 were documented medication resistance cases. Of the total 1100 Line Probe Assay (LPA) tests done, 69 (6.2%) such samples in the Tuberculosis band were absent. Of the real samples tested by LPA, Tuberculosis band (TUB) was present in 1031 samples (93.7%), of which 24 (2.3%) were multidrugresistant (MDR), 121 (11.7%) were rifampicin mono-resistant, 42 (4.0%) were isoniazid mono-resistant, 8 (0.77%) were extensively drugresistant (XDR), and 836 (81%) samples were pan-sensitive. Smoking remained an independent risk factor for poor treatment outcomes in the multivariate analysis (p-value = 0.014, OR = 4.356, 95% CI [1.425�12.45]). This study found a low incidence of Drug-Resistant Tuberculosis (DR-TB). Most of the cases were resistant to first-line anti-tuberculosis drugs. Special attention should be paid to high-risk DR-TB patients to improve treatment results even further. Further studies are recommended with a large sample size.

Drug Resistance and Molecular Characteristics of Mycobacterium tuberculosis: A Single Center Experience.

In recent years, the incidence of tuberculosis (TB) and mortality caused by the disease have been decreasing. However, the number of drug-resistant tuberculosis patients is increasing rapidly year by year. Here, a total of 380 Mycobacterium tuberculosis (MTB)-positive formalin-fixed and paraffin-embedded tissue (FFPE) specimens diagnosed in the Department of Pathology of the Eighth Medical Center, Chinese PLA General Hospital were collected. Among 380 cases of MTB, 85 (22.37%) were susceptible to four anti-TB drugs and the remaining 295 (77.63%) were resistant to one or more drugs. The rate of MDR-TB was higher in previously treated cases (52.53%) than in new cases [(36.65%), p < 0.05]. Of previously treated cases, the rate of drug resistance was higher in females than in males (p < 0.05). Among specimens obtained from males, the rate of drug resistance was higher in new cases than in previously treated cases (p < 0.05). Of mutation in drug resistance-related genes, the majority (53/380, 13.95%) of rpoB gene carried the D516V mutation, and 13.42% (51/380) featured mutations in both the katG and inhA genes. Among the total specimens, 18.68% (71/380) carried the 88 M mutation in the rpsL gene, and the embB gene focused on the 306 M2 mutation with a mutation rate of 19.74%. Among the resistant INH, the mutation rate of −15 M was higher in resistance to more than one drug than in monodrug-resistant (p < 0.05). In conclusion, the drug resistance of MTB is still very severe and the timely detection of drug resistance is conducive to the precise treatment of TB.

PHYSICAL CONDITIONS OF THE ENVIRONMENT IN PATIENTS WITH DRUG RESISTANT TUBERCULOSIS (RO TB)

Background: It is not like where Tuberculosis patients live to be one of the global supporters of burden disease, especially in Indonesia. Economic problems are a trigger for low patient awareness in paying attention to living conditions. This incidence can be a supporting factor for the onset of RO TB. Objective: Knowing the home condition of Drug Resistant Tuberculosis (RO TB) patients. Method: Is an analytical research with a cross sectional approach. Analysis of the home physical condition of Drug Resistant Tuberculosis (RO TB) patients.Results: There are three variables of residential buildings, namely the type of residence, the wall of the dinggal, and the ceiling of the residence that meets the criteria standards of Law No. 01 of 2011. Conclusion: The home of RO TB patients is included in the category of meeting the requirements for a healthy residence so that there are other factors that cause RO TB in the patient's living environment.

Predictors of unfavourable treatment outcome in patients diagnosed with drug-resistant tuberculosis in the Torres Strait / Papua New Guinea border region.

Drug-resistant tuberculosis (DR-TB) is an ongoing challenge in the Torres Strait Islands (TSI) / Papua New Guinea (PNG) border region. Treatment success rates have historically been poor for patients diagnosed with DR-TB, leading to increased transmission. This study aimed to identify variables associated with unfavourable outcome in patients diagnosed with DR-TB to inform programmatic improvements. A retrospective study of all DR-TB cases who presented to Australian health facilities in the Torres Strait between 1 March 2000 and 31 March 2020 was performed. This time period covers four distinct TB programmatic approaches which reflect Australian and Queensland Government decisions on TB management in this remote region. Univariate and multivariate predictors of unfavourable outcome were analysed. Unfavourable outcome was defined as lost to follow up, treatment failure and death. Successful outcome was defined as cure and treatment completion. In total, 133 patients with resistance to at least one TB drug were identified. The vast majority (123/133; 92%) of DR-TB patients had pulmonary involvement; and of these, 41% (50/123) had both pulmonary and extrapulmonary TB. Unfavourable outcomes were observed in 29% (39/133) of patients. Patients living with human immunodeficiency virus, renal disease or diabetes (4/133; 4/133; 3/133) had an increased frequency of unfavourable outcome (p <0.05), but the numbers were small. Among all 133 DR-TB patients, 41% had a low lymphocyte count, which was significantly associated with unfavourable outcome (p <0.05). We noted a 50% increase in successful outcomes achieved in the 2016-2020 programmatic period, compared to earlier periods (OR 5.3, 95% Confidence Interval [1.3, 20.4]). Being a close contact of a known TB case was associated with improved outcome. While DR-TB treatment outcomes have improved over time, enhanced surveillance for DR-TB, better cross border collaboration and consistent diagnosis and management of comorbidities and other risk factors should further improve patient care and outcomes.